Perimenopause

Question 1

Menopause definition

Answer 1

Permanent cessation of menstrual periods, determined retrospectively after a woman has experienced 12 months of amenorrhea without any other obvious pathological or iatrogenic cause
Median 51.4 years
From ovarian follicular depletion, low estrogen and high FSH

Question 2

Premature ovarian insufficiency

Answer 2

Menopause before age 40

Likely an unstable state of ovarian hormone fluctuations

Question 3

Perimenopause definition

Answer 3

The menopausal transition
Generally begins 4 years before the final menstrual period
Characterized by irregular cycles, endocrine changes, vasomotor symptoms, beginning of lipid changes and bone loss
Can be most symptomatic at this time

Question 4

Menstrual cycle changes in the late reproductive years

Answer 4

FSH slightly increases
Estradiol stable (no vasomotor symptoms yet)
Luteal phase progesterone levels begin to decrease
Follicular phase starts to shorten leading to shorter cycles

Question 5

PALM COEIN for abnormal uterine bleeding in perimenopause

Answer 5

Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified

Question 6

Investigations for abnormal uterine bleeding in menopause

Answer 6

B-HcG
CBC, ferritin, TSH, PRL
US
Endometrial biopsy and update pap testing
Dont test FSH, LH, estradiol and progesterone because they fluctuate too much

Question 7

Absolute contraindications to estrogen containing products

Answer 7

< 6 weeks postpartum (clot risk)
Smoker > 35 yo
HTN (> 160/100)
Personal hx of VTE
Ischemic heart disease
Prior stroke
Complicated valvular heart disease
Migraine with focal neurologic symptoms
Breast cancer
Severe cirrhosis
Liver tumor
Diabetes with end organ damage

Question 8

Vasomotor symptom treatment options

Answer 8

Low dose combined pill/patch/ring
Progesterone only txs (less effective)
Non hormonal options (venlafaxine, clonidine, paroxetine)